AB0502 STRESS AS POTENTIAL PATHOGENIC FACTOR IN PRIMARY SJOGREN’S SYNDROME.
Authors: M. Jaskólska, D. Jaskólski, M. Ziętkiewicz, A. Viti, Z. Zdrojewski
Journal: Annals of the Rheumatic Diseases (2022)

Background Sjogren’s Syndrome (SS) is a common autoimmunological disorder characterized by infiltration of exocrine glands by autoreactive immune cells that lead to the disease’s two most common symptoms — dry eyes and a dry mouth, also known as sicca syndrome. The etiopathogenesis considers the coexistence of genetic predisposition and environmental factors, such as viral infections or sex hormones imbalance. Objectives The aim of the study was to determine whether major stressful life events are also risk factors for developing SS. Methods We performed a matched case-control study. Cases were patients with an established diagnosis of primary SS (pSS) within the previous five years. Controls were patients with osteoarthritis in whom systemic connective tissue disease has been ruled out. Data on major stressful life events were collected using the modified Holmes-Rahe stress scale. Data were collected for the period of the year before the disease onset. Results 100 patients were enrolled in the study (pSS group = 50, control group = 50), mean age was 55.8±10.4 years for pSS and 61.3±9.59 years for control group, in both groups 96 % of patients were female. pSS patients had significantly higher total score on Holmes-Rahe stress scale within the preceding 1 year before the onset of disease symptoms than control group (pSS group = 152±66.3 vs control group = 50±54.6; p&lt;0.001). In pSS group 50 % of patients reported the subjective impression that the symptoms were caused by stress, while in control group it was 12 % (p&lt;0.001). The most frequently mentioned life events in the pSS group were divorce or marital separation, death or change in health of family member and stress related to work. Conclusion Patients with pSS are significantly more likely to have had a major stressful life event within the preceding 1 year before the disease onset. The relationship between stress and the occurrence of many diseases and their exacerbations is well documented, especially within autoimmune diseases. Stress is a ubiquitous problem these days, therefore it is of fundamental importance to understand the biological mechanisms underlying its influence on the development of diseases. It is crucial to properly recognize the stressful situation in the patient’s life and undertake appropriate interventions in order to prevent health consequences. References [1]Sandhya P, Kurien BT, Danda D, Scofield RH. Update on Pathogenesis of Sjogren’s Syndrome. Curr Rheumatol Rev. 2017;13(1):5-22. doi: 10.2174/1573397112666160714164149. PMID: 27412602; PMCID: PMC5280579. [2]Sharif K, Watad A, Coplan L, Lichtbroun B, Krosser A, Lichtbroun M, Bragazzi NL, Amital H, Afek A, Shoenfeld Y. The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev. 2018 Oct;17(10):967-983. doi: 10.1016/j.autrev.2018.04.005. Epub 2018 Aug 14. PMID: 30118900. [3]Skopouli FN, Katsiougiannis S. How stress contributes to autoimmunity-lessons from Sjögren’s syndrome. FEBS Lett. 2018 Jan;592(1):5-14. doi: 10.1002/1873-3468.12933. Epub 2017 Dec 22. PMID: 29223133. [4]Roberts AL, Malspeis S, Kubzansky LD, Feldman CH, Chang SC, Koenen KC, Costenbader KH. Association of Trauma and Posttraumatic Stress Disorder With Incident Systemic Lupus Erythematosus in a Longitudinal Cohort of Women. Arthritis Rheumatol. 2017 Nov;69(11):2162-2169. doi: 10.1002/art.40222. Epub 2017 Oct 12. PMID: 28929625; PMCID: PMC5659907. [5]Lee YC, Agnew-Blais J, Malspeis S, Keyes K, Costenbader K, Kubzansky LD, Roberts AL, Koenen KC, Karlson EW. Post-Traumatic Stress Disorder and Risk for Incident Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2016 Mar;68(3):292-8. doi: 10.1002/acr.22683. PMID: 26239524; PMCID: PMC4740283. [6]Warren S, Greenhill S, Warren KG. Emotional stress and the development of multiple sclerosis: case-control evidence of a relationship. J Chronic Dis. 1982;35(11):821-31. doi: 10.1016/0021-9681(82)90047-9. PMID: 7142361. Disclosure of Interests None declared